Staffing and Health Outcomes in Nursing Homes for Residents with and without Dementia

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PROJECT SUMMARY/ABSTRACT Nurse staffing – registered nurses, licensed practical nurses, and certified nurses’ assistants – have long been considered an important factor determining the quality of care that nursing home residents receive and their health outcomes. Information about nurse staffing levels are included in Nursing Home Compare (NHC), the report card published by the Centers for Medicare & Medicaid Services (CMS) as one of the three 5 Star sub-measures, as well as the overall 5-Star measure. Many states and the Federal Government have established minimum staffing standards for nursing homes. These attest to the importance that policy makers, experts, advocates, and residents place on staffing, as both determinants and indicators of quality. With the increasing prevalence of Alzheimer’s disease and related dementias (ADRD), nursing homes are facing an increasing population of residents with dementia (RWD). These residents are expected to require even higher staffing levels, compared with residents without ADRD. Yet, the information about, and our understanding of the needs for staffing other than nursing, such as therapists and social workers, and specifically how nurse staffing and other professional staff influence health outcomes for RWD is lacking. The objective of this proposal is 1) to address this gap in knowledge; and 2) to assess the impact of the projected increase in RWD in nursing homes on workforce requirements. This has been identified as an important policy objective, as indicated in the National Institute on Aging’s Research Milestone 13.J. The specific aims of the application are: 1) To apply econometric techniques to administrative data to estimate the effects of short- and long-term variations in nursing, therapy and social work staffing levels to several short- and long-term outcome measures for nursing homes treating a small percent and a large percent of RWD, and to assess the incremental staffing requirement by staff type and health outcome required in nursing homes with a high population of RWD compared with nursing homes with a low population of RWD; 2) To determine the implications of the findings for nursing homes and for local, state and national labor markets based on projected prevalence of RWD in nursing homes; and 3) To develop a web-based application for policy and decision makers based on our findings, which would allow them to test the impact of different ADRD and RWD growth scenarios and staffing standards policies on workforce predictions at the nursing home and market level.